Provider Demographics
NPI:1659914539
Name:ATRIUM HOUSE CALL CLINIC, LLC
Entity Type:Organization
Organization Name:ATRIUM HOUSE CALL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:
Authorized Official - Last Name:AHANONU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-564-8159
Mailing Address - Street 1:9550 FOREST LN STE 619
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5905
Mailing Address - Country:US
Mailing Address - Phone:972-439-5208
Mailing Address - Fax:214-617-0503
Practice Address - Street 1:10729 AUDELIA RD STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-1000
Practice Address - Country:US
Practice Address - Phone:972-270-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty